1. Cady, Rebecca F. JD, BSN, RNC

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Coast Plaza Doctors Hospital v. UHP Healthcare (2003 DJAR 859)

The Second District California Appeals Court held that the Knox-Keene Health Care Service Plan Act does not preclude a hospital from obtaining reimbursement directly from a health insurance plan, and does not preclude the provider from seeking payment directly from the plan under the unfair competition law for alleged violations of the Knox-Keene Act, when there was no intermediary between the provider and the plan.


Clark Regional Medical Center v. United States (314 F3d 241)

Hospitals denied reimbursement based on provision of medical services to low-income patients under Medicare Part A prospective payment system sued Health and Human Services (HHS) alleging that HHS arbitrarily and capriciously violated its own regulations for counting beds in denying them reimbursement. The US Court of Appeals held that HHS's decision to exclude swing beds from bed counts was arbitrary and capricious.


Doe v. Medlantic Health Care Group, Inc. (No. 00-CV-247, 00-CV-275)

In this unpublished opinion, the District of Columbia Court of Appeals heard a case brought by a patient for invasion of privacy and breach of confidential relationship against a hospital, alleging that the hospital's receptionist disclosed to the patient's coworkers his AIDS diagnosis. The court held that expert testimony was not required to establish the applicable standard of care for maintaining confidentiality of medical records.


Cruze v. National Psychiatric Services, Inc. (129 Cal Rptr 2d 65)

Plaintiff sued a psychiatric hospital to which she had been involuntarily committed for evaluation. The court held that the hospital was an "individual' under the Lanterman-Petris-Short Act and thus was immune from action on medical malpractice and other claims based on Plaintiff's involuntary commitment.


Plummer v. Community General Hospital of Thomasville, Inc. (573 SE2d 596)

A hospital's termination of its contract with an anesthesiologist's employer and entering into an exclusive contract with another company did not effectively terminate the anesthesiologist's medical staff privileges and therefore he was not entitled to notice and a hearing as provided by the hospital's bylaws.


Bergstrom v. Palmetto Health Alliance (573 SE2d 805)

A hospital did not owe a duty to an adoptee to follow its own adoption policies and procedures. Any duty that the policies created was between the hospital and the mother, not the hospital and the baby (adoptee). The hospital could not have foreseen that following the mother's instructions to release the baby (adoptee) to the mother's attorney would result in a failed adoption by nomadic parents who sexually exploited adoptee.


Rodriguez v. Prommer (B154808)

In this unpublished case, the court held that a patient could not recover against a hospital and its employee for deceit, when the hospital's employee wrongly represented to the patient's attorney that the patient had never been treated there. The court held that the attorney's reliance on the employee's representation was unreasonable.


President v. Jenkins (2003 WL 252077 2/6/03 New Jersey)

In New Jersey, a hospital's bylaw requiring physicians to have professional liability insurance does not give rise to a duty on the part of the hospital to monitor and enforce the physician's compliance with this requirement for the benefit of patients whom the physician admits to the facility. New Jersey law does not impose a statutory duty on the hospital to assure that its physicians have malpractice insurance.


Whack v. St. Mary's Hospital of Brooklyn (2003 WL 230702 Slip Opinion, New York City Civil Court 1/22/03)

A hospital was found to be liable for allowing the body of a deceased patient to decompose prior to pickup by the funeral home.


St Luke's Methodist Hospital v. Thompson (315 F3d 984, 2003)

The Secretary of HHS's interpretation of a regulation implementing a Medicare statute in the Provider Reimbursement Manual that created a gap within which there was no reimbursement for the provision of atypical services for a hospital-based skilled nursing facility was erroneous.


Ligouri v. Wyandotte Hospital and Medical Center (655 NW2d 592, 2003)

In a case alleging negligence and breach of contract arising from a patient fall, the court ruled that the hospital's investigative reports and related documents were privileged from disclosure under statutes protecting quality assurance or peer review reports from subpoena.


Green v. Lake Forest Hospital (781 NE2d 658, 2002)

In a wrongful death suit, the plaintiff sought production of the involved nurse's suspension and termination forms. The court held that although the nurse's suspension form was not privileged, the hospital was not required to disclose the contents of the termination form.


Wilson v. Barnesville Hospital (2002 WL 31163394 [Ohio App 7 Dist])

In an action alleging negligence by a hospital in credentialing a physician, the Peer Review Act did not bar discovery of the entire Peer Review file. The Health Care Quality Improvement Act did not bar discovery of the Peer Review file, but some documents in the credentialing file were protected, including: records or a transcript of the proceedings of a review committee which considered the conduct of the defendant; any evidence produced or presented at such proceedings unless the evidence became available to a subpoenaed witness in any other capacity besides as a member of the committee; any finding, recommendation, evaluation, opinion, or other action of the committee.


University Health Services, Inc. v. Long (561 SE2d 77 [Georgia, 2002])

A physician was not entitled to have the court enter an injunction prohibiting a hospital from revoking his privileges pending a final resolution of a lawsuit brought by the physician against the hospital. The court was required to defer to the hospital's governing board regarding the physician's medical skill and judgment. The hospital had found that the physician's care was adversely affecting patients and the court was required to defer to the hospital's medical judgment in the case. The harm to patients outweighed any potential harm to the physician.


Carroll v. Paddock (764 NE2d 1118 [Illinois, 2002])

A not-for-profit charitable hospital and a not-for-profit mental healthcare organization were not "local public entities" as defined by the Local Governmental and Governmental Tort Immunity Act and therefore neither the entities nor their employees were entitled to invoke the protection of the Act.


In Re Investigation of Liberman (646 NW2d 199 [Michigan, 2002])

Documents created by a peer review body exclusively for peer review purposes were not subject to disclosure pursuant to a search warrant in a criminal investigation.


Schiavone v. Victory Memorial Hospital (738 NYS2d 87, 2002)

A hospital was held vicariously liable for the negligence of an independent contractor emergency room physician in a case in which a patient who later died from a heart attack had entered the emergency room seeking treatment from the hospital rather than a specific physician of the patient's own choosing.


Britt v. Shelby County Health Care Authority (2003 WL 133022 [Alabama, 2003])

In this unpublished decision, a respiratory technician employed by the defendant hospital was seriously injured in a car accident when she fell asleep at the wheel while driving home after working two 16-hour shifts in a 40-hour period. She sued the hospital asserting negligence and wantonness as well as filing a Workers' Compensation claim. The State Supreme Court held that the employee's claims could not be sustained.


McElwee v. Leber (57 PaD&C 4th 378, 2002)

Parents who observed a lack of medical care for their child along with their being present when the child lost her pulse and became cold and mottled were entitled to bring a claim against the hospital for negligent infliction of emotional distress as well as other claims.


Trangle v. Rojas (2002 WL 31667848 [Ohio App 8 Dist])

In a lawsuit alleging negligent credentialing against a hospital, any documents generated by the hospital for a peer review purpose were statutorily privileged, but materials received by the committee which were available from their original sources were discoverable. When a hospital claims the peer review privilege, the trial court must hold an in-camera inspection of information, documents, or records in order to determine admissibility. Names of individuals who participated in the process of appointing the physician in question to the hospital staff or who investigated his qualifications and applications for staff privileges were not discoverable.


Klippel v. Rubenstein (751 NYS2d 553, 2002)

A hospital was not vicariously liable for the negligence of certain doctors who responded to an emergency page and assisted in the treatment of a patient in the hospital's labor and delivery room in a case in which plaintiffs failed to produce any evidence regarding the nature of the relationship between the hospital and the physicians or the level of control or supervision, if any, that the hospital exercised over them; the patient was not admitted into the emergency room seeking treatment from the hospital, but was admitted seeking treatment from a specific physician.


Hunt v. Lincoln County Memorial Hospital (2003 WL 183793 [8th Circuit, Missouri])

The Emergency Medical Treatment and Active Labor Act (EMTALA) does not create a general federal cause of action for medical malpractice in emergency rooms. The patient did not have a valid EMTALA claim because his claim was not that he received nonuniform treatment, but that he received incorrect treatment.



St Mary's Medical Center of Evansville v. Loomis (2002 WL 31974123 [Indiana Court of Appeals])

The appeals court upheld a verdict of $16,950,000 awarded to a neurosurgeon who was permanently injured when he slipped and fell on standing water in a pantry on one of the hospital's patient units.


Greenwell v. Kaplan (Contra Costa County, CA Superior Court)

An infant who was born with cerebral palsy was awarded $59,317,500 against the defendant hospital for negligence during the labor and delivery. The physician was not found negligent.


Confidential v. Confidential

In this California case, a college student who suffered severe brain damage due to excessive use of an anesthetic during a therapeutic abortion was given $3,000,000 in settlement of the case.



The United States Pharmacopeia (USP) has announced recommendations for preventing medication errors in children which it says often occur when a decimal point is misplaced in calculating the medication dose or in conversion of weight from pounds to kilograms. Among the recommendations is that dosage forms that are compounded, prepared in serial dilutions, or extensively manipulated be prepared in the pharmacy and verified by a pharmacist. More information is available at USP's Web site,


The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has issued a Sentinel Event Alert on infection control-related sentinel events. The full text of this alert is available at


Under a new rule published in January by Centers for Medicare and Medicaid Services (CMS), the federal government has instructed hospitals to develop and implement a quality assessment and performance improvement (QAPI) program which is to include, among other things, preventive measures that foster patient safety and reduce medical errors. This final rule became effective on March 25, 2003.


A new rule proposed by DHHS Centers for Medicare and Medicaid Services (42 CFR Part 413 RIN 0938-AK02, 2/10/03) would remove the cap on allowable Medicare bad debt for end-stage renal disease facilities and expand the application of a 30% reduction in bad debt reimbursement for hospitals to other Medicare providers or entities currently eligible to receive bad debt reimbursement. The rule would also clarify that bad debts are not allowable for entities paid under reasonable charge or fee schedule methodologies.


The Department of Health and Human Services (DHHS) has published a final rule establishing requirements and procedures for external quality review of Medicaid managed care organizations and prepaid inpatient health plans. The rule, 42 CFR Parts 433 and 438, became effective March 25, 2003.


DHHS has published a final rule amending the fire safety standards for hospitals, long-term care facilities, intermediate care facilities for the mentally retarded, ambulatory surgery centers, hospices that provide inpatient services, religious nonmedical healthcare institutions, critical access hospitals, and programs of all-inclusive care for the elderly facilities. The rule also adopts the 2000 edition of the Life Safety Code. The citation for this rule is 68 FR 1374, and it will become effective September 11, 2003. Facilities have until March 13, 2006 to comply with certain parts of the rule.


The Agency for Healthcare Research and Quality has launched a Web-based National Quality Measures Clearinghouse, which contains the most current evidence-based quality measures and measure sets available to evaluate and improve the quality of healthcare. The Web site is located at


The New York Times (January 24, 2003) reported that Kaiser Permanente will publish on its Web site the guidelines used by its physicians for treatment of various conditions, and has agreed to make public information about the way it pays doctors, including financial incentives. These actions are part of a settlement of two lawsuits brought by consumer groups over patient care.


According to a study of 168 hospitals in Pennsylvania, for each additional surgical patient over four in a registered nurse's workload, the risk of death increases by 7% for those patients. The study was published in an article entitled "Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction" in the October 23, 2002 issue of the Journal of the American Medical Association.


A new publication published by the American Hospital Association (AHA), American Psychological Association (APA), American Psychiatric Nurses Association (APNA), and National Association of Psychiatric Health Services (NAPHS) provides strategies to lessen the need for restraint and seclusion with psychiatric patients. The document, entitled "Learning From Each Other: Success Stories and Ideas for Reducing Restraint/Seclusion in Behavioral Health," is available at under "what's new."


According to Consumer Reports (January 2003), information regarding quality of hospital care is becoming available on the Web. The Texas Health Care Information Council publishes data on Texas hospitals at Information regarding New York hospitals is available at


Consumer Reports, January 2003 issue, featured a special report entitled "How Safe Is Your Hospital?" in which 21,000 of its readers rated care from hospitals throughout the country. The article identified three critical factors in patient satisfaction and quality of care: sufficient staff (especially RNs), good systems for organizing care, and lots of experience with the particular medical condition at issue. This article is worth a read for all healthcare providers and hospital administrators. This article is available online at


Both houses of Congress introduced legislation in February that would limit the use of mandatory overtime for nurses. Under both bills, healthcare facilities that receive Medicare funding would be prohibited from requiring nurses to work more than 12 hours in a 24-hour period or more than 80 hours in a 2-week period, except during an emergency declared by national, state, or local officials. The bills would also provide protection for nurses who refuse overtime or cooperate with investigations about the use of overtime.


HR 663, a bill that would be a first step toward fostering a nonpunitive environment for reporting and discussing medical errors, has made it out of committee. The bill provides legal protection for information collected to advance patient safety research and education.


The AHA has issued an advisory regarding the Health Insurance Portability and Accountability Act (HIPAA), including updated guidelines for the release of patient information, and has developed a toolkit designed to help hospitals explain HIPAA and prepare physicians and staff about the changes. This information is available at


HHS has adopted final security standards for electronic health information under HIPAA. The complete text of the final rule is available at


The New York Times (February 18, 2003) reported that a federal appeals court has ruled that consumers can sue a health insurance company for injuries resulting from the company's refusal to authorize medically necessary treatment. The case was decided in the United States Court of Appeals for the Second Circuit in New York and is entitled Cicio v. Vytra Healthcare.


JCAHO has released a report regarding the value and importance of nurses and strategies for addressing the nursing staffing crisis. The full report is available at


A study published in the January 16 edition of the New England Journal of Medicine identified risk factors for retained objects after surgery. These included emergency procedures, a change in procedure, and high patient weight.


The Institute of Medicine has released a report entitled "Priority Areas for National Action: Transforming Health Care Quality" which identified 20 priority areas to focus upon to improve healthcare quality and delivery. The report is available online at




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